title: A randomised controlled trial to evaluate and optimize the use of antiplatelet agents in the perioperative management in patients undergoing general and abdominal surgery--the APAP trial (ISRCTN45810007).
abstract: BACKGROUND
  Due to the increase of cardiovascular diseases acetylsalicylic acid (ASA) has become one of the most frequently prescribed drugs these days. Despite the rising number of patients with ASA medication presenting for elective general and abdominal surgery and the potentially increased risk of hemorrhage in these patients, there are no clear, evidence-based guidelines for the perioperative use of antiplatelet agents. The present randomised controlled trial was designed to evaluate the safety and optimize the use of ASA in the perioperative management of patients undergoing general and abdominal surgery.
  
  
  METHODS
  This is a two-arm, monocenter randomised controlled trial. Patients scheduled for elective surgical treatment (i.e. inguinal hernia repair, cholecystectomy and colorectal resections) with ASA as a permanent medication are randomised equally to perioperative continuation or discontinuation of ASA. Patients who are randomised in the discontinuation group stop the administration of ASA five days prior to surgical treatment and start intake of ASA on postoperative day 5. Fifty-two patients will be enrolled in this trial. The primary outcome is the incidence of postoperative bleeding and cardiovascular events at 30 days after surgery. In addition a set of general as well as surgical variables are analysed.
  
  
  CONCLUSIONS
  This is a randomised controlled two-group parallel trial designed to assess the safety and optimize the use of ASA in the perioperative management of patients undergoing general and abdominal surgery. The results of this pilot study build the basis for a confirmative randomised controlled trial that may help to clarify the use and potential risk/benefits of perioperative ASA medication in patients undergoing elective surgery.
  
  
  BACKGROUND
  The trial is registered with Current Controlled Trials ISRCTN45810007.
authors.affiliation: Department of Surgery, University of Heidelberg, Germany. dalibor.antolovic@kssg.ch
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic
authors.forename: Christoph
authors.initials: C
authors.lastname: Reissfelder
authors.forename: Anastasia
authors.initials: A
authors.lastname: Rakow
authors.forename: Pietro
authors.initials: P
authors.lastname: Contin
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002763:Cholecystectomy; D002985:Clinical Protocols; D003082:Colectomy; D017558:Elective Surgical Procedures; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin